This is a continuation of grant R01 DA07957 The Effects of Prenatal Cocaine Exposure in Adolescence, a longitudinal study of the prenatal effects of cocaine/polydrug exposure. The current cohort includes 359 (183 prenatally cocaine exposed (PCE), 176 non-cocaine exposed (NCE)) adolescents, representing 89% retention of living subjects. In prior studies we found specific effects of PCE on cognition (perceptual reasoning, executive function, and language), externalizing behavior and teen substance use compared to NCE youth from birth through 15 years. We have also identified the effects of elevated lead levels, iron deficiency and the differential impact of non-kinship foster or adoptive care placement as important contributors to early developmental outcomes in this cohort. To date there is a lack of knowledge about the effects of PCE on emerging adulthood (EA), a time marked by rapid and stressful transitions. We propose to follow this large, well-retained cohort at age 20, with the overarching objective of determining whether the negative effects of PCE on development identified earlier in this cohort continue to interfere with optimal developmental outcomes in EA. In particular we examine whether PCE is related to increased rates of substance use disorders, antisocial behavior and poorer adaptive functioning, and whether pre-existing cognitive deficits persist and mediate the expected effects of PCE on problem behaviors. Emerging adults will be assessed using self- report, interview, bioassay and neurocognitive assessments. Specific aims are to: 1) assess effects of PCE on substance use disorders, antisocial behavior and adaptive functioning in EA; 2) determine if cognitive problems previously identified in this cohort among PCE children persist into EA and to examine whether these pre- existent cognitive problems and early behavior problems mediate expected effects of PCE on substance use disorders, antisocial behavior and poor adaptive functioning; and 3) identify environmental and biologic factors that may moderate developmental outcomes in EA among prenatally cocaine/polydrug exposed individuals by examining gender, placement history, elevated blood lead, iron status and childhood adversity. Our conceptual model, drawn from the neurobehavioral teratology, developmental psychopathology and common liability to addictions models, focuses on the effects of PCE on SUDs, antisocial behavior and adaptive functioning and examines a set of potential cognitive and behavioral mediators and biologic (elevated lead level, iron status, gender) and environmental (childhood placement, adversity) moderators. Multivariate analyses, structural equation modeling, survival analyses and latent class growth analysis will be used to address these specific aims. The results of this study will assist in designing properly timed prevention and substance use treatment interventions for emerging adults. These strategies can reduce the number of individuals at risk for costly lifelong problems associated with substance use disorders.

Public Health Relevance

A pattern of specific cognitive deficits (executive function, inhibitory control, auditory processing, and perceptual reasoning), externalizing behaviors and teen substance use has been identified in prenatally cocaine exposed children, yet there is no data on this population during emerging adulthood. This study will determine if PCE increases the risk of substance use disorders, antisocial behavior, and poor adaptive functioning in emerging adulthood and if earlier cognitive deficits persist and mediate cocaine's effect on these outcomes. Research on prenatally cocaine exposed emerging adults will aid in identifying modifiable risk factors for the development of well-timed, targeted substance use prevention programs.